July 1st, 2014

Health Connector woes impact coverage

A temporary solution to the state’s healthcare signup woes has caused more issues for some Massachusetts psychologists and their clients.

This spring, the state began putting a short-term fix in place for residents who were having difficulty in signing up for subsidized health insurance through the state’s online health insurance exchange Web site, called the Massachusetts Health Connector. Approximately 31,000 people who applied for coverage but were not enrolled because of glitches in the system were placed on temporary coverage.

But the fix left at least one serious hole, some psychologists in the state are finding. The temporary coverage does not, they say, include outpatient therapy by independent psychologists.

“So many people were trying to get health care through the Health Connector,” says Charles Wolfson, Ph.D., a clinical psychologist with a private practice in Westborough, “and now there is a huge backlog so they put them on MassHealth, which is good. But they either forgot or deliberately decided not to add in the carve out for mental health care.”

MassHealth uses Massachusetts Behavioral Health Partnership (MBHP) to provide mental health care as part of their Standard plan, Wolfson explains. The temporary enrollees, however, were not given access to that carve out coverage he discovered in researching the issue.

“I think this may be an error on MassHealth’s part,” Wolfson says. “They may have forgotten to tack it on. It should be a routine thing.”

“These people,” he adds, “are getting substandard version of MassHealth Standard.”

According to Julie Kaviar, deputy communications director for the Executive Office of Health and Human Services, the state is working on getting everyone on to the subsidized plans as soon as possible.

“We understand that the temporary coverage does not cover certain outpatient psychotherapy services provided by psychologists and other practitioners in individual or group practices, as it is temporary coverage and is not designed for our managed care program. Temporary coverage insures consumers for the majority of their health care needs,” she says. “We are working hard to determine coverage eligibility so all consumers can access their full health care benefits as soon as possible.”

For psychologists, such as Wolfson, who were already treating patients who are affected by this issue, the decision becomes one of refusing care or of working out other payment plans with patients. He attempted to get the issue cleared up with MassHealth, to be told by a customer service representative only that these patients do not have the MBHP coverage.

“If you try to get information, you can’t get anywhere. I am seeing one patient for free because I had been seeing him for a long time and he needs therapy every week. I can’t say, ‘I’m not going to see you anymore. Go to a clinic,’” Wolfson says.

According to the MassHealth Web site, temporary coverage should include “health care services from providers that participate in the MassHealth program…services, including doctor and clinic visits, hospital stays, prescription medicines [and] mental health…”

“The thing is,” says Wolfson, “people are coming in with temporary MassHealth because the letter they get in the mail says to call to see if the therapist is a MassHealth provider and I am a provider. I kept billing MassHealth and was not getting paid.”

Upon calling MassHealth, Wolfson was told that his services were not covered in this circumstance.

“Since psychologists and social workers cannot bill MassHealth for therapy,” says James Leffert, Ed.D., chair of the advocacy committee for the Massachusetts Psychological Association (MPA), “there is no way for them to collect.”

The root of the problem stems from a 2003 regulation, says Michael Goldberg, Ph.D., director of professional affairs for the MPA that prohibits MassHealth from paying for outpatient care for psychotherapy provided by independent psychologists. The carve out plan with MBHP was introduced for mental health care to cover those services. Otherwise, independent psychologists are covered, he explains, for testing only. Instead, those patients are required to see a therapist through a community mental health center.

Goldberg is looking to meet with the director of behavioral health for MassHealth to determine if the temporary problem can be fixed and to get an understanding of how long they expect these clients to be on this temporary plan.

Beyond the immediate dilemma for psychologists and patients, he says, the 2003 regulation will need to be addressed with the state to keep the problem from re-occurring.

“In the long term, this has reawakened the need to change that regulation,” Goldberg says, “and we will vigorously advocate for doing that.”

The current situation has highlighted what may have been an issue for MassHealth clients all along, he adds, and there is no way to ascertain how many regular MassHealth clients have been denied access  to independent practitioners.

“A lot of people placed on the temporary plan had commercial insurance before,” he says, “and will again so they are used to seeking services from private practitioners that take most commercial insurance,” which has brought the issue into the light.

By Catherine Robertson Souter

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